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Medicine | IN PRACTICE

Free, but costly to his principles

May 14, 2007|Steve Dudley | Special to The Times

It's only Thursday and already I'm beat. As usual, I'm swamped: phone calls to return, charts and labs to review, all sandwiched between my regular schedule of patients. I love them, but the frenetic pace wears me down. There is hope in sight: On Thursdays, the drug reps cater lunch. They roll out the red carpet, flatter and regale me with all sorts of impressive-sounding scientific studies, all showcasing their drug.

Today's menu: Caesar salad, veal Parmesan, Italian rolls, marinated veggies and tiramisu. The only thing missing is the Chianti. They've also brought free pens with prominent drug logos, Post-its and some sort of candy dispenser that I can't figure out. Of course, they've also got the smartly packaged drug samples, free for the asking.

A well-dressed woman who looks as if she belongs on Wall Street greets me with a smile I could pour on my pancakes. I feel underdressed in my khaki slacks and Dr. Seuss tie. She beckons me to sit down, take a load off my feet and dig into the veal Parmesan. Her chummy sidekick chimes in, right on cue, that they'd like to update me on their latest drug.

So, along with lunch, I am being treated to a well-rehearsed play, complete with drama, heroes (their drug) and villains. And they dive right in with lengthy descriptions of case studies, sample size, confidence intervals, head-to-head drug trials. Don't they realize that this is not a research institution, just a clinic on the corner?

I smile wanly. I just want to get this food down in peace. Yes, there's no such thing as a free lunch -- and I'm paying for this one. As I eat, I hear about their drug going against old-time drug Brand X. And, of course, their drug is the hands-down winner in all the studies, no surprise there.

I listen politely and even agree to use their drug. I'm always polite. And I haven't had the tiramisu yet. Everyone is happy. Yet there's a little devil on my shoulder whispering in my ear, wanting to stir up the pot. Should I tell them about their competitors who breezed through earlier in the week inviting me to the ballgame: box seats, free beer and brats? But I don't. I am a polite doctor, choosing not to bite the hand that feeds me. And, oh, that tiramisu looks good.

The free pens are nice. I'm frequently losing pens, so these will come in handy. I can always use the Post-its too. And these friendly people with their $600 suits take such an interest in me. For 30 minutes, I feel like a king. The least I can do in return is prescribe their drug. What does it matter to me?

And then it hits me. No, not a severe case of dyspepsia from seconds on the veal. I'm talking about the big picture. When patients come to see me, they expect me to be their advocate, free from external influences. People trust me. They willingly place the most intimate details of their lives in my hands.

Afterward, late in the afternoon, I step into Room 7. One of my older patients is eager to see me. He's not doing well. In spite of his advanced age and feeble health, he is trying to care for his ailing wife at home, with the assistance of home nurses. He is utterly lost without his wife. He adores her so much. She is his whole world.

He is looking for solace, hope ... anything to ease the pain of losing his soul mate. I think to myself that she's dying -- there's nothing we can do.

But you can't tell someone in the midst of a crisis something like that. What he wants is hope in the form of a pill. Something to help her talk or sleep or be less depressed, anything.

I want to help him. He needs something to hang his hopes on. And about then, I burp. The acid taste of tiramisu rises in my throat, burning the whole way up. It sure tasted good at the time, but I'm not so sure now. Nevertheless, this brief eructation reminds me of my wonderful meal and those kind people who went out of their way to bring it to me. Didn't they leave plenty of samples of that new antidepressant? Lucky for my patient that he came in today instead of yesterday. The sample cabinet is full of brightly packaged pills with pictures of smiling people.

I suggest that I think we may be able to help his wife with one of the new pills, an antidepressant. It works great and just may help perk her up.

My patient reaches for the little box of pills as earnestly as if it were a life ring from the Titanic. He turns it over and over clumsily in his calloused hands, examining it every which way, this new little talisman. His face brightens. His tears dry up. He has hope. And I have played a part. I'm a hero. I like that.

What I don't tell him is that it's not much different than older drugs, just newer and sexier -- and pricier, once the free samples run out. We'll deal with that later. I'm in a bit of a rush right now. First pitch is at 7:05 and the beer and brats are waiting for me.


Steve Dudley is a family physician in Seattle.

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